MEDICARE: LIRIE ALEXANDRA DOYLE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3351	PR
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144788795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIRIE ALEXANDRA DOYLE DMD

Provider Business Mailing Address
First Line	:	140 CALLE REY FERNANDO
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 AVE DE DIEGO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2214
Country	:	US
Telephone Number	:	787-908-2072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	01/24/2025

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